The Cough

I remember …

the scene and the day so well. It was a Saturday, early March. COVID had not quite landed in Michigan in vigor. I had parked outside a new donut shop and saw an all too large crowd assembled inside a very small space. I would not enter. Not until everyone had vacated. I saw someone I recognized. Her daughter was coughing, and she was clearly unwell. The young girl went inside the shop, but soon came out, coughing and uncomfortable. Her father rebuked her. The cough had become a harbinger. They left without the donuts, and a new normal would descend all around us.

I have had compelling urges to cough inside small spaces – gas station depots, patient rooms, even during a vaccine study – largely prompted by the differing masks that tickled my nose and irritated my senses. Yet I held it. I actively, and rather uncomfortably, suppressed my cough. I did not want to be that vector that everyone was worried about being in the same room with.

We know that droplets aerosolize and travel – and travel well beyond the 6 feet distance we have all come to heed as the safe zone. Aerosolized particles may linger in the air for hours before falling to the ground. They may travel well over twenty feet. So where did the six feet distance come from, you may ask.

The larger lesson I wish to prevail upon is this: the virus is real. Our reactions are borne out of the uncertainties of who harbors the virus and if they are among the asymptomatic population that unwittingly, unintentionally, walk among us as sources of spread.

So when will coughing become normal. When can an asthmatic with cough, a reflux sufferer with cough, someone choking on their saliva or candy, or a physician like myself, with a normal everyday urge to cough, all be allowed to do so without stigma?

The answer, in part, is this – not yet. Not until we see a plateau in our numbers. Not until the nation as a majority, and all states across the nation regard the imperative and this legitimate call to action. So long as our numbers continue to rise and the virus remains out of handle, any perceptible signs of COVID-19 remain a real and hostile force to be reconciled.

I ask that you wear a mask. I ask that you point your face towards the floor when coughing and sneezing – both reasonable urges and necessary. If you feel compelled to cough in your elbow, do so, but turn away from those nearest you. It is incredibly uncomfortable to suppress a cough or a sneeze. I have tried. And I trust you have too. When you face the ground and bend down to cough you are enabling aerosolized particles to drift down to the ground quickly and expediently.  When you tuck the sneeze in your elbow you are letting those around you know I will protect you as I know you will continue to protect me. When you wear a mask, you are indicating safety first among all people. When you uncomfortably try to suppress a cough or a sneeze you are silently swearing: this disease is real, this virus looms among us, and I want to be part of the solution.

So when will we ever cough again as a normative part of our existence: when we all require a respect for this deadly virus that has cost more lives in a day than on September 11, 2001, than Pearl Harbor, than all mass shootings in a decade. The claim this virus will have had on our nation, on this world, will have been irreparable to the families and nations who have lost citizens and front-line workers confronting this pandemic. Cough into your elbow or facing the floor and show those around you: I care about you and I am part of the solution. Even as the vaccine feels close, the imperative to remain safe and engaged can not waver, nor should we.

Yours in health,

Dr. Abha

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